Hip Flashcards
(79 cards)
1
Q
Hip Joint ROM needs for functional activities
A
120 flexion
20 abduction
external rotation
2
Q
What 3 joints support the hip
A
Iliofemoral
Pubofemoral
Ischiofemoral
3
Q
What do the 3 ligaments collectively limit
A
hip extension
–tightly coiled around capsule in extension to give hip stability
4
Q
Anterior hip Joints
A
Iliofemoral-Y ligament, strongest ligament
**limits IR and EXT
Pubofemoral-limits abduction
5
Q
Posterior hip joint
A
Ischiofemoral- limits IR and Adduction
6
Q
Acetabulum
A
made up of fusion of:
Ilium
Ischium
Pubic Bones
concave
deepened by ring of fibrocartilage labrum
- -hyaline cartilage decreases the forces of friction
- -Thicker on lateral aspects b/c forces more on lateral side
7
Q
Open Pack of hip
A
30 flex
30 abd
slight ER-10-15 degrees
8
Q
close pack of hip
A
full ext
slight abd
slight IR
9
Q
Arthrokinematic motion of FEMUR on ACETABULUM
A
Flex: posterior Ext: Anterior Abduction: inferior Adduction: superior IR: posterior ER: anterior
10
Q
Normal end feels of hip
A
flexion: soft
Ext: abduction, adduction, ER, IR- firm
11
Q
Angle of inclincation
A
angle between axis of femoral neck and shaft of femur
NORMAL: 125 degrees
12
Q
Coxa Valga
A
greater than 135 degree angle and results in long leg on that side and genu varum
- -longer leg on coxa valga
- -leg will bow out–>varum @ knee
13
Q
Coxa Vara
A
less than 120 degrees angle and results in short leg on that side and genu valgum
- -shorter leg on coxa vara side
- -valgum at knee
14
Q
angle of torsion
A
–angle formed by transverse axis through the formal condyles and axis of neck of the femur
–normal 10-15 degrees
15
Q
Anteversion
A
Increased angle of torsion
femoral shaft is rotated medially
RESULTS IN:
genu valgum
pes planus
**internally rotated and foot pronated
16
Q
Retroversion
A
Decreased angle of torsion
femoral shaft rotated laterally
RESULTS IN:
long leg
genu varum
**externally rotated and femoral head rotates more in line w/ condyles
17
Q
Hip flexor muscles
A
psoas major
iliacus
rectus femoris
18
Q
Hip extension muscles
A
gluteus maxiums-attaches to ITband
hamstrings
19
Q
hip abductors
A
gluteus medius
gluteus minimus
TFL/IT band
20
Q
Hip adductors
A
pectinus
gracilis
adductor magnus, brevis, longus
21
Q
External rotators
A
piriformis
quadratus femoris
obturator externus, internus
gemellus superior, inferior
22
Q
internal rotators
A
gluteus minimus, medius
Tensor Fascia Latae
23
Q
Active insufficciency
A
hamstrings in prone knee flexion
24
Q
Passive insufficiency
A
Hamstrings in supine with straight leg raise
25
Anterior Pevlic Tilt
ASIS moves downwardly and anteriorly
Hip Flexors (iliopsoas and Sartorius) pull down anteriorly
Erector Spinae pull up posteriorly
POSITION: increased hip flexion and lumbar spine extension
OBSERVE: hip flexors, back extensors, abdominals and hip extensors
-excessive femoral IR
26
Compensations for Anterior Pelvic Tilt
Femur IR
genu valgum
lateral tibial torsion
pes planus
27
Posterior Pelvic Tilt
ASIS moves upwardly and posteriorly
Rectus Abdominus pulls up anteriorly
Gluteus Maximus and hamstrings pull down posteriorly
POSITION:
-increased hip extension and trunk flexion
OBSERVE:
- hip flexors, back extensors, stability form Y ligaments
* people rest on Y ligaments
28
Compensastions for Posterior Pelvic Tilt
```
hip extension
Femur ER
genu recurvatum
genu varum
pes valgus
```
29
Lateral Pelvic Movement
pelvic drop of less than 5 degrees on swing leg side
gluteus medius on stance side ccontracts to hold up pelvis on swing leg side
IF glute med weak= Trendelenburg Gait
30
Pelvic Rotation movement
keeps body's center of gravity within its base of support
forward motion of pelvis
femur opposite side is rotated internally
31
Common sources of pelvic/hip pain
```
sciatic nerve-passes under piriformis
SI joint
lumbar and lumbar/sacral joint
bursae
OA-groin pain
```
32
Acetabular Labral Tear or Femero Acetabular Impingement
groint pain
usually people younger than 40 y.o
athletes-soccer and gymnastics
33
Faber's Test
figure 4 test
identifies arthritis of hip, SI joint involvement, iliopsoas problem
Patient supine w/ knee flexed
What to do:
- Therapist Flexes, Abducts, ER hip and rests lateral malleolus on opposite knee above patella
- Therapist applies downward force
* will feel pain in general hip
* SI=back pain
* iliopsoas= more groin pain
34
Thomas Test
Identifies hip flexor tightness
What to do:
* patient supine with non-test limb in full hip and knee flexion held by patient
* limb to be tested is off of exercise surface
Normal:
*thigh level with exercise surface
knee flexion of 80 degrees or greater
35
1 Joint Muscle tight- Thomas Test
hip in flexion
knee can flex to 80 degrees
**Psoas and iliacus
36
2 Joint muscle tight: Thomas test
thigh level with exercise surface- 0 degrees of hip flex
knee flexion less than 80 degrees
**Sartorius, TFL, rectus femoris
37
1 & 2 Joint tightness -Thomas Test
hip in flexion
| knee in flexion less than 80 degrees
38
Ober Test
Identifies tightness in ITB or TFL
Patient sidelying w/ test limb up
Passively abducts and extends limb and allow limb to lower
If limb does not drop to 10 degrees below horizontal the IT/TFL is tight
Ober test: knee flexed to 90 degrees
Modified Ober: knee straight
39
True Leg Length Discrepancy Test
identifies leg length asymmetry
Patient supine
measure from ASIS to Medial Malleolus
If knee projects anteriorly: femur is longer
If knee projects superiorly: tibia is longer
40
Legg-Calve_Perthes Disease
- affects children between 2-12 y/o
- noninflammatory, self-limiting syndrome
- femoral head becomes flattened at WB surfaces= disruption of blood supply
- abductor orthosis
TREATMENT GUIDELINES
-must keep hip abducted during ROM and strengthening exercises
41
Slipped Capital Femoral Epiphysis
The neck of the femur slips upwardly and anteriorly at epiphysis
ETIOLOGY
- epiphyseal plate is at risk of displacement before it fuses in adolescent years
- can be idiopathic or due to trauma
- occurs btw. 10-15 y/o
- occurs in males more than female: 2 to 1
42
Clinical Signs of slipped capital femoral epiphysis
present with mild to moderate pain at hip and sometimes knee
Dx on x-ray
surgical fixation
43
Total HIP-THA/THR Indications
decreased functional ability to ambulate or perform ADLs/Functional Roles
hip instability
avascular necrosis
previous hip surgery failure
44
Cemented THR
```
prosthesis is cemented to existing bone
usually older patient
usually immediate WBAT
Disadvantage
-has higher incidence of loosening
```
45
Non-cemented THR
prosthesis allows for bony in-growth
usually for younger pts.
usually more stable and lasts longer
TTWB or PWB for 6 weeks up to 3 months
46
THR anterolateral approach
```
older approach
glute med is cut
other muscles disturbed:
glute min
TFL
Iliopsoas
rectus femoris
```
47
Hip Precautions for anteriorlat approach
no hip flexion > 90
no hip extension
no adduction past neutral
no ER past neutral
48
ADL reminders for Anteriorlat approach
no prone lying
no bending forward in sitting position-putting on socks
no tailor sitting
no pivoting on involved leg
49
THR anterior approach
TFL is divided longitudinally
1/2 of glute med is released
Vastus Lateralis is divided longitudinally
HIP PRECAUTIONS
- check w/ MD
- Sometimes hip extension and ER limitations
- sometimes no hip precautions
50
Posteriorlateral Approach THR
- most common
- glute max is divided in line with muscle fiber alignment
- glute med and vastus lateralis not cut-> strong ability to abduct
- Highest percentage of post-surgical dislocations
51
Hip Precautions for posteriorlateral THR
no hip flexion > 90
no IR past neutral
No adduction past neutral
```
ADL reminders:
no sitting on low chairs
no bending of waist > 80
no crossing legs
no pivoting on involved side
no laying on involved side for 8-12 weeks
```
52
Minamaly invasive surgical THR
can be lateral, posterior or anterior
smaller incision: 1 or 2
check with MD protocol
evidence base practice
-presently no evidence to support quicker recover times with minimally invasive THR
0all approaches achieve similar outcomes at 6 months and 1 year post-op
53
Treatment considerations for all THR
```
ensure no hip dislocation
bed mobility with precautions
prevent DVT
early rehab management:
-open chain exercise
-transfer training
-initiate ambulation w. appropriate AD
-initiate ambulation with typical environmental home barriers
```
54
Hip hemiarthroplasty surgical procedure
surgical procedure where only priximal femur is replaced
follow MD protocol
55
hip resurfacing surgical procedure
similar to THA but removes less bone
cap placed within femur with matching Cup placed within acetabulum
56
Precautions for Hip resurfacing
prone lying alllowed to decrease contractures
active hip abduction allowed
strengthening exercises for hip abduction and extension begun early in rehab
keep hip in neutral IR/ER for first 6 weeks
57
Hip fractures
70% occur in people older than 70
90% occur from falls
Most common fracture: intertrochanteric Fracture
*proximal femur fracture
58
complications from hip fractures
```
compromised blood supply to the head of the femur
fracture is displaced
delayed healing or non-healing fracture
avascular necrosis of head of femur
often results in THA
```
59
ORIF following hip fracture: rehab management
```
similar to THA program
usually no hip precautions
follow MD WB precautions
-DVT
-non-union/ failed surgical intervention
```
60
Tendonitis/ Muscle Strain
can be one specific event or occur secondary to overuse
CLinical findings:
- localized pain at muscle belly, insertion or origin
- pain reproduce with an active contraction or stretching of the involved muscle
- most common in hamstrings, adductor longus, iliopsoas or rectus femoris
Initial rehab: Acute/protection Phase
- RICE
- protect muscle during healing process
61
Hip Pointer
direct trauma to subcutaneous tissues of iliac crest
Acute/Protection Phase:
-RICE
62
Bursitis
Inflammation of Bursa
aggravated when muscle over bursa is stretched or contracts
CLINICAL SIGNS:
- pain in area of inflammation
- pain with muscle stretching or resisted testing
- gait deviations
- decreased muscle endurance
63
Greater Trochanteric Bursitis
inflammation of bursa located between glute med/ IT band and greated trochanter
often due to compression and friction from tight ITBAND
usually there is a pelvic asymmetry
--check lumbar and SI joints
Clinical SIGNS:
- pain over lateral hip, lateral thigh to knee
- pain aggravated by stair climbing
- pain may awaken patient at night
64
Psoas Bursitis
inflammation of bursa that is below Iliopsoas near anterior capsule of hip
often due to activities that require excessive/reptative hip flexion=running,swimming
CLINICAL SIGNS:
- pain in groin area, can go to patella
- pain with resisted hip flexion
65
Ischiogluteal Bursitis
-inflammation of bursa located near ischial tuberosity
often due to sitting on hard surface and/or excessive -hamstring contraction-running, jumping
-slow to heal, difficult to treat
CLINICAL SIGNS:
- pain at Ischial Tuberosity
- pain with palpation of ischial tuberosity
- pain increases with walking, climbing stair
- may present with sciatica
66
Maximum Protection Phase
```
limit aggravating activities
alter lifestyle
STM, joint mob for pain relief-improve motion
control WB forces
posture
well joint mechanics
progressive ROM
flexibility
stationary biking, pool
multi-plane isometrics
supplemental modalities for inflammation control
```
67
Controlled motion phase
CRITERIA:
- decreased pain
- improve pain-free ROM
- ability to full WB
```
return to full WB w/ minimizing gait devviations
gain maximal ROM
increase strength-function patter
muscle flexiblity and strength balance
balance strategies
begin to return to funcitonal acitivites
```
68
Return to Function Phase
CRITERIA:
- max ROM and strength
- Appropriate balance strategies
- no gait deviations
gain max strength
max functional acitivities
plyometrics
sports related activities if appropriate
69
Hip Flexor tightness
stresses back-increase lumbar extension as thigh extends into gait
stresses knee-if during gait hip cant move into full extension
the femur cant move as far posteriorly and lock the knee as it should
70
TFL tightness
*IF IT band is not long enough*
to slide easily over hip which may result in trochanteric bursitis
slide easily over knee which may result in lateral knee pain
may pull the patella laterally which may result in patellafemoral impairment
pelvic may anteriorly tilt which rotates femur internally stressing medial knee too
71
Hip Abdcutor, ER and/or extensor tightness
increase femoral IR and adduction w/ knee valgum increasing
results in:
- piriformis syndrome-over use from ER of femur compresses sciatic nerve
- patellofemoral impairment
- anterior cruciate strain-valgus increases anterior shear of tibia
72
Total Hip phase 1
post op
0-3 days after
gaosl:
- bed mobility
- minimal assistance
- maintain precautions
- ambulation
- regain 80 degrees of PROM and AROM of hip flexion
73
Criteria to move to phase 2
hip flexion 0-90 degrees
hip abduction 0-30 degrees
independt transfers and abmulation w/ AD
74
Phase 2 rehab
day 3- 6 weeks
motion phase
goals:
- strenghten entire hip
- begin proprioceptive training
- continue gait and endurance
Week 1-4:
- AROM hip abduction, quad, hamstring, glute isometris
Week 4-6:
-continue/progress above exercises with resistance
75
Criteria to move to phase 3
AROM of hip motion 0-110
good quad control
independently ambulate 800 ft. w/o AD or gait deviations
76
Phase 3
7-12 weeks
adequate strength of all LE muscles
return to functional activities
77
Criteria to move to phase 4
4+/5 of all LE muscle
| minimal to no pain or swelling
78
Phase 4 rehab
return to appropriate sports/rereational activities
| increase endurance and strength
79
Criteria for DC
AROM
4+/5 strength
normal age-appropriate balance and proprioception
independent in HEP
